UPSC-CMS 2022 - Obstetrics and Gynecology Practice Questions

Q: Which of the following is a contraindication for insertion of Intrauterine Contraceptive Device (IUCD)?

Suspected pregnancy. ***Suspected pregnancy*** - Insertion of an IUCD into a pregnant uterus is an **absolute contraindication** (WHO MEC Category 4). - Can lead to **septic abortion**, **miscarriage**, **uterine perforation**, or **ectopic pregnancy complications**. - **Pregnancy must be ruled out** before IUCD insertion through history, examination, and urine pregnancy test if indicated. *Age > 35 years* - Age alone is **not a contraindication** for IUCD insertion. - IUCDs are safe and highly effective for women over 35 years. - In fact, IUCDs are often preferred for older reproductive-age women due to high efficacy and non-hormonal options. *Severe dysmenorrhea* - **Not an absolute contraindication** for IUCD insertion. - **Copper IUCDs** may worsen dysmenorrhea and should be used with caution. - **Levonorgestrel-releasing IUCDs (LNG-IUS)** are actually **therapeutic** for severe dysmenorrhea and reduce menstrual blood loss. - The type of IUCD can be selected based on the clinical scenario. *Multiple sexual partners* - **Not a contraindication** for IUCD insertion per WHO Medical Eligibility Criteria. - While multiple partners increase STI risk, this can be addressed through **STI screening** and **barrier contraception counseling**. - IUCDs do not increase risk of PID in women without current cervical infection. - The outdated concern about PID risk has been refuted by modern evidence.

Q: The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is

penicillin. ***penicillin*** - **Penicillin G** is the drug of choice for intrapartum GBS prophylaxis due to its **narrow spectrum** and proven efficacy in preventing neonatal GBS disease. - It rapidly achieves bactericidal concentrations in the amniotic fluid, effectively eradicating GBS from the maternal genital tract during labor. *doxycycline* - **Doxycycline** is a **tetracycline antibiotic** generally contraindicated in pregnancy due to potential adverse effects on fetal bone and tooth development. - It is not effective against GBS and is not used for its treatment or prophylaxis in pregnant women. *vancomycin* - **Vancomycin** is reserved for pregnant women with **severe penicillin allergy** (e.g., anaphylaxis) or isolates with known resistance to penicillin and clindamycin. - Its use is limited due to the need for intravenous administration and potential for ototoxicity or nephrotoxicity. *azithromycin* - **Azithromycin** is sometimes used for GBS prophylaxis in cases of penicillin allergy but is **less preferred** than clindamycin due to emerging GBS resistance. - It is not considered a first-line agent, and susceptibility testing is crucial if it is considered for use.

Q: Which of the following is NOT a component of the combined prenatal screening test in the first trimester?

2. MS AFP (α-Fetoprotein). ***2. MS AFP (α-Fetoprotein)*** - **MS AFP (maternal serum α-Fetoprotein)** is primarily used in the **second-trimester screening** (quad screen or triple screen) to detect **neural tube defects** and certain chromosomal abnormalities. - It is **NOT part of the first-trimester combined screening test**. - The first trimester combined screening is performed between **11-13+6 weeks** of gestation. *1. β-hCG* - **β-hCG** (beta-human chorionic gonadotropin) is a key biochemical marker used in the first-trimester combined screening. - Abnormal levels of **β-hCG** (elevated in Down syndrome, decreased in Trisomy 18) are integrated with other markers to calculate risk for chromosomal abnormalities. *3. Nuchal translucency* - **Nuchal translucency (NT)** measurement is a crucial ultrasound marker used in the first-trimester combined screening test. - Increased NT thickness (≥3.5 mm) is associated with a higher risk of **aneuploidies** (Down syndrome, Trisomy 18, Trisomy 13) and certain structural cardiac defects. *4. PAPP-A* - **PAPP-A** (Pregnancy-Associated Plasma Protein-A) is a biochemical marker included in the first-trimester combined screening. - Low levels of **PAPP-A** are associated with an increased risk of Down syndrome and other adverse pregnancy outcomes.

Q: Which of the following are correct regarding Placental Site Trophoblastic Tumour (PSTT)? 1. Low serum β-hCG 2. Composed mainly of cytotrophoblast 3. Highly responsive to chemo radiation 4. Confined to endometrium without myometrial invasion

1. Low serum β-hCG. ***Low serum β-hCG*** - **PSTT** originates from intermediate trophoblasts, which produce **human placental lactogen (hPL)** rather than **β-hCG**, leading to relatively low serum β-hCG levels. - This low **β-hCG** is a key differentiator from other gestational trophoblastic neoplasms like **choriocarcinoma**. *Confined to endometrium without myometrial invasion* - **PSTT** is known for its **local invasiveness** and frequently invades into the **myometrium**, and may even penetrate the serosa. - Its infiltrative growth pattern can lead to **uterine rupture** and significant **hemorrhage**. *Composed mainly of cytotrophoblast* - **PSTT** is primarily composed of **intermediate trophoblasts**, not cytotrophoblasts. - These intermediate trophoblasts are characterized by their **mononuclear appearance** and distinctive immunohistochemical staining pattern, including positivity for **hPL** and **cytokeratin**. *Highly responsive to chemo radiation* - PSTT is **not highly responsive** to chemotherapy; it often exhibits **chemoresistance**, especially in advanced stages. - Because of its chemoresistance, **surgery** (hysterectomy) is the primary treatment for localized disease, and systemic therapy options are more challenging.

Q: Metroplasty is the surgical procedure done for which one of the following uterine anomalies?

Septate uterus. ***Septate uterus*** - **Metroplasty**, specifically **hysteroscopic metroplasty**, is the primary surgical treatment for a septate uterus to remove the fibrous or muscular septum dividing the uterine cavity. - This procedure aims to improve reproductive outcomes by restoring normal uterine anatomy and reducing the risk of miscarriage or preterm birth. *Arcuate uterus* - An **arcuate uterus** is a mild indentation of the uterine fundus, considered a normal variant or a minor anomaly, and does not typically require metroplasty or surgical correction. - It is usually **asymptomatic** and not associated with increased risks of adverse pregnancy outcomes. *Uterus didelphys* - **Uterus didelphys** is characterized by two completely separate uteri, cervices, and often two vaginas, due to complete non-fusion of the paramesonephric ducts. - Surgical intervention like metroplasty is generally **not indicated** as it would involve fusing two distinct uteri, which is not feasible or beneficial. *Imperforate hymen* - An **imperforate hymen** is a congenital anomaly where the hymen completely obstructs the vaginal opening. - The surgical procedure for an imperforate hymen is a simple **hymenotomy** or hymenectomy to create an opening, not a metroplasty, as it involves the hymen and not the uterus itself.

Q: Which of the following is MOST effective as a first-line management for premenstrual syndrome?

Combined oral contraceptive pills. ***Combined oral contraceptive pills*** - **Combined oral contraceptive pills** are the **most comprehensive first-line pharmacological treatment** for **premenstrual syndrome (PMS)** by suppressing ovulation and stabilizing hormonal fluctuations throughout the menstrual cycle. - They address both physical and mood-related symptoms of PMS effectively. - Continuous or extended-cycle regimens can be particularly beneficial by reducing the number of menstrual periods and related symptom flares. *Niacin (vitamin B3)* - There is **no robust scientific evidence** to support the efficacy of **niacin (vitamin B3)** in the management of PMS symptoms. - While **vitamin B6** has some evidence for mild PMS symptoms, **niacin (B3)** is not recommended. - High doses of niacin can cause side effects such as flushing, itching, and gastrointestinal upset. *Diuretics* - **Spironolactone**, a potassium-sparing diuretic, can be effective for managing **specific fluid retention symptoms** associated with PMS, such as bloating and breast tenderness. - However, diuretics are typically used as **adjunctive therapy** for specific symptoms rather than comprehensive first-line management. - They do not address the broader spectrum of emotional and psychological symptoms of PMS. *Hysterectomy with oophorectomy* - **Hysterectomy with oophorectomy** (removal of the uterus and ovaries) is a **last-resort treatment** for severe, refractory Premenstrual Dysphoric Disorder (PMDD) after all medical therapies have failed. - This is an **irreversible surgical procedure** that induces immediate surgical menopause with significant risks and long-term implications. - It is **never a first-line treatment** for PMS management.

Q: Which of the following is the marker of ovarian reserve?

Anti-Mullerian hormone. ***Anti-Mullerian hormone*** - **Anti-Mullerian hormone (AMH)** is produced by the granulosa cells of small antral and pre-antral follicles in the ovary. - AMH levels correlate with the size of the **primordial follicle pool**, making it the **most reliable indicator of ovarian reserve**. - Unlike other markers, AMH remains relatively **constant throughout the menstrual cycle** and can be measured on any day. - AMH is the **preferred marker** in fertility assessment and IVF planning. *β-hCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a hormone produced during pregnancy by the developing placenta. - Its presence indicates pregnancy and is not a marker for **ovarian reserve**. *Placental alkaline phosphatase* - **Placental alkaline phosphatase (PLAP)** is an enzyme produced by the placenta. - It serves as a biological marker for certain cancers (e.g., germ cell tumors) and sometimes for placental function, but not **ovarian reserve**. *Serum estradiol* - **Serum estradiol** levels fluctuate significantly throughout the menstrual cycle and are influenced by numerous factors. - While **Day 3 estradiol** combined with FSH was historically used for ovarian reserve assessment, elevated levels can indicate poor reserve (due to early follicular recruitment). - However, it is **not as reliable or cycle-independent as AMH** for assessing the overall **follicle pool**.

Q: In the PALM-COEIN classification by FIGO for abnormal uterine bleeding, ovulatory dysfunction is the cause in which one of the following conditions?

Polycystic ovarian syndrome. ***Polycystic ovarian syndrome*** - **Polycystic ovarian syndrome (PCOS)** is a chronic anovulatory disorder, making it a primary cause of **ovulatory dysfunction (O in PALM-COEIN)**. - The hormonal imbalances in PCOS interfere with normal follicular development and ovulation, leading to irregular or absent periods and abnormal uterine bleeding. *Pelvic inflammatory disease* - **Pelvic inflammatory disease (PID)** is an infection of the upper female reproductive tract causing inflammation, but it does not directly lead to primary ovulatory dysfunction. - PID falls under the **"E" for Endometrial causes** in the PALM-COEIN classification if it causes bleeding through endometrial inflammation or infection. *Adenomyosis* - **Adenomyosis** is a condition where endometrial tissue grows into the muscular wall of the uterus, causing heavy and painful periods. - This condition is classified under **"A" for Adenomyosis** in the PALM-COEIN classification, representing a structural cause of abnormal uterine bleeding, not ovulatory dysfunction. *Ovarian cancer* - **Ovarian cancer** is a malignancy of the ovaries and, while it can cause abnormal bleeding in advanced stages, it is not primarily due to ovulatory dysfunction. - Ovarian cancer is classified under **"M" for Malignancy and hyperplasia** in PALM-COEIN, indicating a structural and pathological cause, rather than an ovulatory problem.

Question 1

Which of the following is a contraindication for insertion of Intrauterine Contraceptive Device (IUCD)?

Accepted Answer

Suspected pregnancy

Answer

Age > 35 years

Answer

Severe dysmenorrhea

Answer

Multiple sexual partners

Question 2

Regarding the phenomenon of ‘lightening’ in primigravida at term pregnancy, which one of the following statements is correct?

Accepted Answer

It is a welcome sign since it indicates descent fetal head into pelvis.

Answer

It occurs earlier in primigravida compared to multigravida.

Answer

There are no bladder or bowel symptoms associated with this phenomenon.

Answer

It is associated with worsening cardiorespiratory embarrassment in mother.

Question 3

The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is

Accepted Answer

penicillin

Answer

doxycycline

Answer

vancomycin

Answer

azithromycin

Question 4

Which of the following is NOT a component of the combined prenatal screening test in the first trimester?

Accepted Answer

2. MS AFP (α-Fetoprotein)

Answer

1. β-hCG

Answer

4. PAPP-A

Answer

3. Nuchal translucency

Question 5

Which of the following are correct regarding Placental Site Trophoblastic Tumour (PSTT)?

1. Low serum β-hCG
2. Composed mainly of cytotrophoblast
3. Highly responsive to chemo radiation
4. Confined to endometrium without myometrial invasion

Accepted Answer

1. Low serum β-hCG

Answer

4. Confined to endometrium without myometrial invasion

Answer

2. Composed mainly of cytotrophoblast

Answer

3. Highly responsive to chemo radiation

Question 6

Metroplasty is the surgical procedure done for which one of the following uterine anomalies?

Accepted Answer

Septate uterus

Answer

Arcuate uterus

Answer

Uterus didelphys

Answer

Imperforate hymen

Question 7

Which of the following is MOST effective as a first-line management for premenstrual syndrome?

Accepted Answer

Combined oral contraceptive pills

Answer

Hysterectomy with oophorectomy

Answer

Diuretics

Answer

Niacin (vitamin B3)

Question 8

Which of the following is the marker of ovarian reserve?

Accepted Answer

Anti-Mullerian hormone

Answer

β-hCG

Answer

Placental alkaline phosphatase

Answer

Serum estradiol

Question 9

In the PALM-COEIN classification by FIGO for abnormal uterine bleeding, ovulatory dysfunction is the cause in which one of the following conditions?

Accepted Answer

Polycystic ovarian syndrome

Answer

Pelvic inflammatory disease

Answer

Adenomyosis

Answer

Ovarian cancer

Question 10

Which of the following is INCORRECT regarding endometrial cancer?

1. Persistent progesterone stimulation is an important etiology.
2. It is more common in white population.
3. HNPCC (Hereditary Nonpolyposis Colorectal Cancer) syndrome is a high risk factor.
4. Adenocarcinoma is the commonest histopathology.

Accepted Answer

1. Persistent progesterone stimulation is an important etiology.

Answer

2. It is more common in white population.

Answer

3. HNPCC (Hereditary Nonpolyposis Colorectal Cancer) syndrome is a high risk factor.

Answer

4. Adenocarcinoma is the commonest histopathology.

UPSC-CMS 2022 — Obstetrics and Gynecology